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Sunday, 2 January 2011

Do you Care about the NHS?

The article below is why I think this government are really, really stupid.

It's the short sightedness you see. When is a saving not a saving? When it costs more than it saves.

The article starts by saying that mental health issues cost the country 105 Billion a year. 105 Billion!! You could practically wipe out the deficit at a stroke if it wasn't an issue. Now, obviously, I'm not claiming that's possible, but research is much less than on cancer or heart disease - just 75 million a year. Those with mental health issues are more likely to die of cancer or a heart attack, but we don't really know why. Labour had pledged to raise research funding from 2% to 11% of the overall research budget, but this is reported to be missing from Lansley's plans, due to be released shortly.

And that's the stupid bit. Stupid, stupid, stupid. According to those that know - The head of the Mental Health Foundation and the Institute of Psychiatry - Every pound spent in research will pay for itself in just three years. Just like the Film council that made £5 for every £1 it was given from the government. Or EMA's, which paid for themselves with some ridiculously low take up figure.

So, I know it's counter-intuitive, I know most of you don't believe me yet, I know you all think Gideon's axe needs to swing, but CUTS DON'T USUALLY SAVE MONEY. Well spent government money, targeted at improving outcomes just mean the public end up paying less in the long run. Perhaps there were schemes that were badly run. Fine, slash away. But if something saves money in the long run, leave it alone.

That money needs to be saved. Somewhere, we do need to find some cash. We could look in Sir Philip "Top Shop" Green's deep, tax-avoiding pockets. We could ask Gideon and his many trustafarian pals to bring their considerable wealth into UK jurisdiction and demand that they pay full UK tax on it. (See Artful Dodger ads to appear in all major newspapers on Tuesday, the day of the VAT rise). We could stop giving tax relief altogether on those who can afford to pay tens of thousands a month into private pensions. Not tax them mind, stop not taxing them. We could crack down on tax havens. We could ask Vodafone to pay the 6 Billion in tax they were allegedly allowed to not bother with. We could bring in that Robin Hood Tax, that just takes a tiny, tiny, fraction of every banking transaction but generates billions in revenue. http://robinhoodtax.org/

The alternative is terrifying. We just don't care about the implications of cutting vital research, support and care. Are we really so naive that we believe the country was sucked dry by hoards of faking sickies, immigrants and dole cheats? Sure there were some, but they sucked several hundred billion less than the bankers. Anyone know how much our banks have paid back of the more than 800 billion they demanded to pay for their greed? Don't you think we should?

The alternative is we leave sick patients to die, we leave the mentally ill untreated, we leave the elderly uncared for, we leave the disabled with no support and on and on and on. Do you want to live in that place?

This article, from the Independent, is a brilliantly comprehensive collection of all the broken promises and outright lies the Conservatives told about health in the run up to the election. Just health mind you, never mind the other departments.

It is not a matter for debate. You can't read it and say, "Oh, well, she would say that." The statistics are all there, the dates and even places of every broken promise, all catalogued. What's more, they are not just Lansley's broken promises, (Health Minister) they are Cameron's. Time and again, he jumped on the bandwagon of the day, promising to improve mental health research, increase midwife numbers, to invest in the NHS, to protect frontline services and improve patient care. Time and again, he's stayed quiet when some Tory minister or another has broken these promises.

I've just spent a month or so in one of the country's flagship hospitals. Where there used to be 6 trained nurses on every shift, there are now three. If you're lucky and no-one calls in sick. Patient's are already being left in their own filth, left in agony for want of some painkillers, drugs are forgotten, pharmacy's are taking hours to fill orders, tests are taking weeks longer, operations are being cancelled, hip replacements and cataracts are now no longer considered a priority, sick patient's are being sent home too soon, wards are closing, midwife numbers have fallen and beds are becoming scarce. The NHS has been asked to make 20 Billion in "Efficiency Savings". Well, they're not efficiency savings, they're cuts, and rumour has it another 10 Billion are on the way. The NHS isn't ring-fenced, it's being strangled.

We can wait, if you like. We can watch people suffer, we can watch people die, we can believe it's necessary to make the sick pay for the greed of the super-rich. We can leave disabled people to rot, we can make tens of thousands of people homeless, we can cut school funding and let the NHS be privatised against the wishes of 90% of it's staff.

Or we can wake up. We can stop sleepwalking into a disaster and we can stop believing the lies Mr Murdoch and Mr Cameron and Mr Osborne and all the others are telling us.

23 comments:

Sue - You are so right to emphasise that cutting does nothing to address the structural deficit. The costs of redundancy, benefits and lost tax revenue from making one public servant redundant are almost the same as keeping them employed... and cutting tax inspectors is even more perverse. According to Tax Research UK, every tax inspector retrieves 30-180K in 'lost' tax over and above their salary. Nevertheless, this government is implementing 30% cuts to HMRC.

We are being sold a cruel and horrendous line about the UK being in a national crisis and that it is all the previous government's fault for overspending!

The facts are that the Labour government ran a deficit that was smaller than any during the Thatcher/Major years: that spending was simply brought forward in 2009 to maintain jobs, prevent mortgage defaults and to create economic growth which was aimed at pulling the economy out of recession. All the evidence is that Darling's plans were working ... and I write as one who is critical of the Darling /Brown approach.

The cuts of this government are purely ideological and without regard for the damage that will be done to vulnerable people's lives. To reiterate we cannot cut our way out of a deficit which was caused by the falling tax receipts after the recession which was caused by 2008 global banking/gambling crisis.

The reduction in trained (ie RNs) staff and their replacement with HCPs (ie HCAs and APs) has been going on for over a decade so whilst I blame the Tories for starting to privatise the NHS back in the 80s, this was actually Labour's policy. RNs cost on average around £100,000 to train whilst an HCP costs considerably less. RN training is pretty standardised, so wherever you train in the UK you come out with comparable skills. HCP training is still pretty hit and miss at the moment. All the research that RN ratios make a big difference to patient outcomes is being ignored....the upfront costs are all that is considered...yes, to staff a 28 bedded ward with the correct ratio (1 to 4) would mean many hospitals having to increase RN numbers by almost 100%. This would be a phenomenal cost. At the same time we would need to increase the numbers of other qualified professionals who are being slowly replaced by "assistants" so more pharmacists, radiographers, physios, OTs, lab staff- the list is endless. So NHS accountants think they are saving by cutting staff. The cost of just one extra patient becoming septic and ending up in the ICU for 10 days (the average length of stay on a ventilator/renal support/inotropes etc, around £3K-£5K per day) and the extra time then recovering on an acute ward (4-12 weeks) would wipe out the cost of an extra 2 RNs ( assuming mid grade Band 5 at the massive cost of £24,000 lol). Unfortunately thats not how these things are looked at.

Dino nurse ... Thank you for giving so much detail which can be used in campaigning either against this government's cuts or for arguing change in LP policy.

As I said in my post, I fundamentally disagreed with the neo-liberal thrust of New Labour... PFI, privatisation, foundation hospitals, competition and applying the dubious concept of 'productivity to health. However, under this government, the NHS is facing destruction of a completely different order.

The optimistic view is that this destruction may eventually facilitate an NHS which does not rely implicitly on the good will and unpaid work of nurses... real change is easier to achieve when there is a crisis! In the meantime, there are desperate times ahead.

You can say it was rubbish under Labour if you like - it probably was, but as a patient, it was a whole lot better than in 1997. If your honest it was a whole lot better for nurses too, even if it was still not good enough. It would have taken 30 years to reverse the nightmare of 18 years of Tory underfunding.

As for research costs. This is much more subjective as it depends on the type of research that you are talking about. If its pharmacuetical then I'm afriad there is no way that a 3 year window works. Average time to develop and test a new drug to the animal stage is around 10 years ( I have alot of friends from university that work in this sector) and the cost per new drug is millions. Less than 5% of drugs that pass toxicity tests make it to human trials and even then the time to recoup costs (patent laws etc) means that Big Pharma is pretty cut throat with where it invests its money. Hence at the moment its all cancer therapies and cardiac drugs, with obesity/diabetes drugs also getting a pretty big cut of the pie. Sad fact is mental illness is not a popular choice with Big Pharma as they very cynically know that the costs to develop these drugs will never be recovered as the biggest world markets (US and Canada) will not buy them. Although both have radically different attitudes to healthcare neither will be able to pay for the longterm use of new expensive drugs- just look at the problems with insulin pumps (pretty cheap in comparison). Under an insurance led system, new meds are often excluded until proven...so that can be decades after first release. Under a state led system, new drugs become widely available once the costs drop considerably from first release, so again around a decade. This works quite well for short term use drugs and most cancer drugs fall into this catagory. Even if they are thousands of pounds a pop, if you can have a fixed term of less than 5 years then chances are that systems will pay up. Take the same costs over decades and the chances reduce drastically. This is not something that is going to change much under either system I feel. Insurance schemes have to recoup costs by increasing premiums and state schemes have to do the same by raising taxes/contributions. Finally, the problem with tax havens- if you start to demand that companies and individuals pay up they just move their money elsewhere. This is not a new problem, its centuries old. The rich stay rich by hiding money and not paying taxes. They do not care if the NHS etc goes to the wall because they can afford private healthcare, private education and if needs be, private binmen, road maintenence etc...in short they have no real need for the public sector. What they do need is a flourishing private sector so that they can make more money. Take this away and they will follow the money. We are already seeing this with Big Pharma where many smaller companies are being bought out and then relocated outside the UK due to costs. The same is true for many other technology based companies. As an aside, why exactly do you think the Tories want to increase an individuals charity contributions? They think that charities can run things like hospitals and social care far more cheaply...because they will send in an army of enthusiatic amateurs/volunteers. Now whilst I have friends who volunteer for mountain rescue, in real life they are nurses, doctors and firemen...ie they know what they are doing when they find you half frozen up a mountain with a broken leg....the alternative?

I trained under the tories and also left to work in the US because of the state of the NHS in the early 90s. When I trained, staffing levels were adequate but patients were less dependant. Alot of the drop-off in nursing numbers had more to do with the unfriendly working hours if you had family commitments. Many of my friends gave up when they had kids. Prior to 1995, most RNs (or RGNs as we were called at the time) were trained under a modular apprentice scheme and were on a salary rather than a grant. This came from the DOH as it was then. The standard joke when P2K first came into being was that we cost three times as much to train. There was also the scrapping of the EN courses and ENs were treated pretty shabbily. Not sure that the statement about training places being cut is that accurate- rather I think the case is that many like me left the UK for the US and Oz for better pay and conditions. Where I trained we had 6 intakes a year of around 30 students- now we have yearly intakes of around 140-200 students. However under the old scheme, most hospitals had students. Nowadays its only the bigger teaching hospitals that take large numbers of students. In reality despite all the flag waving alot of the increase in numbers is due to foreign nurses and doctors wanting to work in the UK and also making it harder for UK nurses to get to the US (changes in training). Recently we have the fiasco that is Agenda for Change...just another way of kicking us when we are down. Most trusts use it as a weapon to prevent progression and pay increases. Doctors were treated in a similiar way with the introduction of MTAS and the career passports...load of garbage that means little in terms of quality or training for them. I think it makes little difference who is actually in power at the time. Under both tory and labour we have seen students qualifying with no jobs to go to, vacancy freezing, privatisation and mass exodus of nurses and doctors to US and Canada etc...

I would be interested in any input from NHS staff who have worked in the continental system.

There, nobody gets worked up about nationalised health services. The system of payment is that if you earning under a certain level you are nationally insured, as we all are here. But if you are earning over that level you have to be privately insured as well. Nobody escapes the national contribution unless of course they are on benefits.

The hospitals are usually run by both institutions and the state which both of course receive grants but also earn from the insurance companies of those compulsorily paying private insurance.

GPs are as here private businesses but receive payments in the same way.

I found it very interesting to view the bills which I had to reclaim from my insurance company.

I just fail to understand what the fuss is about why the provision of services must be nationalised, as opposed to the payment for it.

I also do not understand what is wrong with specifying a level of provision and inspecting to ensure it is maintained, as is done with prisons for instance.

I should also be interested in Dino and others' comments on the current percentage of obese nursing staff, to which I referred in an earlier post. 'Physician heal thyself' comes to mind. Doctors who are alcoholics are also not unknown.

Apart from the appalling illnesses which are suffered by 'innocent' patients, is there not a case to make draconian decisions about those who bring misery upon themselves?

My car accident 30 years ago cost my insurance company tens of thousands. The 'accident' was my fault. Should I not still be making a contribution to my care which saved my leg?

Is there any excuse for being obese and are not the people who serve their loved ones food even after the latter become so obese they can no longer get out of bed, not guilty of a crime?

HowardFirst rule of nursing/medicine etc- we are not there to pass judgements on you. Its very easy to lay blame on people but where would you draw the line? Would you be in favour of making diabetics who have genetic reasons rank more worthy than those who develop the disease because they are overwieght, for example. This starts to drag us along a very dark highway I feel- "the road to hell is paved with good intentions". Start to discriminate like this and where does it end? What is a worthy disease? How about patients with HIV and HepC-would you treat those who caught the virus through blood transfusions and leave the rest to die? Any doctor or nurse who would be prepared to do so has no place in a caring profession. Sure, we all have our personal opinions but just because you disagree with how someone wound up in hospital doesn't mean that they deserve less or second-rate care. Having worked in the US and parts of Europe (France, Switzerland, Germany) I would say that any insurance based system sucks if you have a chronic condition. Many who are unable to work because of chronic conditions are then stuck with the state system which provides only a basic level of care. In the US I frequently saw patients in the ER in DKA (life threatening complication of diabetes). The reason? They couldn't afford to buy insulin. Now I know this isn't the same in all parts of the US as the system varies widely between different states, but just happening in one state was bad enough. In Europe the biggest differences were between who actually qualified for state aid. Certainly when I worked in France, you had to have paid into the system to be able to draw on it, so the very poor got a pretty bum deal and minimal services. Also, France does not give free care to other EU citizens and its pay up BEFORE treatment. Here in the UK they are treated and then chased for payments afterwards. If you are from outside the EU then you would be pretty much stuffed as unless you were destitute you get nothing, although I believe that this is currently under review. Lets face it, most of the rest of the EU actively discourage foreigners from thinking about settling there. The numbers of long term unemployed that are entitled to benefits is less than the UK. In Germany unless you had a disability you got a maximum of 6 months allowance as a "job seeker" and then went onto vouchers. Think France has a similar system for welfare. I have also worked for MSF in Africa and have watched people die from lack of basics like food and water. Antibiotics and treatments witheld from the dying simply because we did not have enough to go around, so they were given to those with a better chance of survival (adults and children alike). Not a choice that I had to make thankfully and you could see the effects on the doctors who did.As for you comment about your leg, well if you are still employed you are still paying into the system. This is the crux of the problem, as I have mentioned before. Assume a working life of 40 years and average NI of £3000 a year. Thats £120,000 paid in (so not actually that much). Assuming half goes to the NHS proper, thats £60,000. Fair enough if, like me, you have never been in hospital, rarely visit the GP and are on no medications. However, my lifetime contributions would keep a single patient in the ICU for between 5 and 12 days. It would pay for half a liver transplant, maybe a week for a premature baby in SCBU. All fine and dandy as long as enough people are paying in. However over the past 20 years we have seen advances in medicine/drugs that are drastically improving survival rates and extending lives that would have had no hope when I first qualified and the costs are rising. If you are unfortunate enough to need nursing home care you are looking at around £600 a WEEK. So your lifetime of savings will not keep you in a home for very long.

Excuse me, but believe me I do NOT want to be overweight. Before I got ill I was a bodybuilder; I had less body fat than the trainer I was paying to help me work out. Then I got sick. Suffice to say the weight went on and I have NO IDEA WHY. I do not go to McDonalds, my son has never had it. There are no crisps, no soda, no junk in my house. I eat on average 1,000 calories a day. So contrary to what someone who sees me on the street may think I am not getting up at eating 10,000 calories around midnight. I have an illness...and no one can figure out what's doing it, but of course I'm told "if I just lose weight" suddenly everything will be fine.

There are a lot of anorexic/bulemic people who are just as pricey to the NHS but they "look fine" so ergo don't get complete strangers coming up to make comments to them, as I do - like it's anyone's business. I'm well aware of the health risks of being this size and believe me I have tried to go back to my biggest love of my life, lifting weights. I was strapping 10kilo weights to my hands as I no longer have sensation and strength in my fingers to lift, but it just wasn't safe; not safe for me, not safe for the other people around me whom I could have crippled for dropping that weight on top of them.

So yes, I think there are a few "excuses", not the least of which being the utter lack of empathy from people who feel they can make sweeping judgments of other people's lives merely by looking at them. And that goes for me or anyone else you may see...eating well is expensive. I pay a lot of money to eat like I do, and when poor that's difficult. I have crippled myself trying to work out because I LOVE working out, but it's the worst thing I can do right now. Nothing irks me more than being told how to diet and "just eat less" as if I hadn't dedicated over 10 years of my life to strength training and nutrition.

Sometimes, there is a damn good reason for someone's body to be in the condition it is, and sometimes, yes, there's an "excuse" for it. I think people who smoke are idiots and cost a fortune on NHS but I'd not want them gasping their last in agony without help.

Howard was asking about nurses Oya's daughter. Ooooohhhhhh believe me, people cone up to insult you if you're too skinny too. "Eat a Fu***ng donut you skinny cow" is a particular fave. "what's it to you, you skinny Fu***ng Belsen refugee bitch" was nice though.I thought the Mum that told her 6 yr old daughter that I was what would happen if she didn't eat properly had great people skills too, but hey, we all have our crosses to bear.There ARE lot's of very overweight nurses, particularly round the bum area, yet they do such a physical job. WhT's that all about?

Dino-nurse - you sound great but oh my lord the judgemental doctors I've encountered!!!! Is there actually a condition that isn't judged? Mental health patients must have it the worst butanyone who's a bit too thin or a bit too fat or has ME or bowel disease or an eating disorder or addiction or alcoholism or lung cancer or cibromyalgia or back pain or chronic pain.....I'm bored of typing but bad doctors would rather blame their patients for almost aanything than actually do some work in my experience.

First of all we are seeing an obesity epidemic across the entire population.

Second of all Nurses work terrible hours with no way of ensuring regular mealtimes. Regular mealtimes are key to weight loss almost more than what a person eats.

It is not uncommon to work a 16 hour day shift and only have 5 minutes to stuff your face with food as a Nurse. There is no place on the ward to store healthy food brought in from home. There is no time to go to the canteen (on the rare occasion it is open). Therefore our faces get stuffed with junk. We then inhale it when we get time. Sometimes I have only 7 hours between leaving work after a long shift and having to come back for another one.

The hours. We switch constantly between day and night shifts in the same week with no pattern, no set rota etc. Every week is different. This will mess up a person's metabolism. Sometimes I am eating my main meal of the day at 9 PM after I get in from a 14 hour day shift. I had to leave for work at 6:15 AM that same day and have no appetite for breakfast at that time. It is a very unhealthy thing to do.

Sometimes I am eating a large meal at 1 AM. when that shift has gone on even longer because my relief didn't show up. Sometimes I have my only meal (and I make it a large one) early in the morning before I go to sleep after a night shift and awake just before I have to leave for another night shift.

I am usually 5'4 and a size 10-12.

About two years ago I temporarily left Nursing because I had enough. I got a 9-5 Monday through Friday job. THE WEIGHT JUST FELL OFF OF ME.

After 3 months of working regular hours in this new non nursing related office job and being able to have regular meal times my clothes were hanging off of me. I went down to size 8. It was the regular hours and regular meals three times a day that made any weight I had fall off.

As a nurse I was frequently skipping meals because of no access to food and workload and then stuffing my face with crap if I had a chance to do so. Not eating for a day and a half and then eating a huge amount of junk is not good.

Your sleep patterns are also messed up when you switch days and nights constantly and that affects how your body deals with calories and fat.

So you are correct in saying that lots of Nurses are fat. They are fat and they preach to patients about healthy eating habits.

Most of the patients have 9-5 monday through friday jobs and therefore they will find it extremely easy to eat healthy and have small frequent healthy meals at regular times throughout the day (the key to weight loss). They are also guaranteed regular hours and lunchbreaks at work. And that also makes it very easy to control their diets. Nurses do not have any of the above factors at work.

It isn't that Nurses won't practice what they preach. They simply cannot practice what they preach because NHS working conditions and hours are so fucked up.

I am still waiting to find out my rota for next week. I need to know what days I am working, which one will be days, which ones will be nights, which ones will be 8 hour shifts and which ones will be 12 hour shifts.

Next week I will find out the schedule for the following week and it will be completely different from the previous week. There is just no way to stay on a schedule and have regular mealtimes.

Dino thank you for pointing out that most people will cost the system a lot more than what they ever, ever put in. It is so true. I cringe when they say "I paid for it" or "I pay your salary".

No. Actually I am paying for your care by working thousands of unpaid hours in appalling conditions. Your tax contributions don't pay for shit. You can't earn enough in your lifetime to pay for all the healthcare that you think you are entitled too. Can't wait till I go abroad. Paid for all hours I work and a nice fat private health insurance plan for my spouse and kids as well. Yippe kay yay m*thaf*cka.

Dino by the way I am flying out for an interview in 'merica next week. At the hospital my mother has major high level connections in.

Two problems though: My spouse doesn't have his visa yet and no one will buy my fecking house.

Looks like I am going to have to leave the old man and the children behind (don't think I will actually have the balls for that as they are still little) for a few months whilst he gets his visa and we pray for a miracle with the house.

I'm aware that thin people get as much issues, as I've been friends with a few models in my day and they were the most emotionally messed up people I've ever met - all due to what other people had to say about them. Hence why I said "So yes, I think there are a few "excuses", not the least of which being the utter lack of empathy from people who feel they can make sweeping judgments of other people's lives merely by looking at them. And that goes for me or anyone else you may see."

However, I don't think the comment was just to nurses, and I'm sure I didn't misread that as he's left comments several times re: people who are overweight. Thereby I stand by my comment.

My son will grow up to pay into pension funds, even though he's not related to the people who collect them, and neither NHS nor the social services system has been of any use whatsoever to either me nor him so it's not like I'm paying back anything I've been given when I've had to fight tooth claw and nail for even the basics. I shouldn't have to fight for it; I put money into the pot when I could work and it went to other people, and now I need a bit of that back from others. Being a part of society does not warrant stinginess or being able to dictate who is "worthy".

Thanks very much for such interesting replies. I think lorry drivers also 'suffer' the meal time problems outlined by Anne (and it shews!).

Clearly the system of nursing is very badly managed not least by the senior professional staff, who should know better. I did not come on here to comment on the state of the NHS nor to pillory any group, my observation about the dietary health of health care professional people was merely that.

Just as relevant to this list is the policies towards promotion of healthy lifestyles prior to people requiring attention by the corrective health services. That is probably a bigger subject for us but I will (again) observe that we are, apart from the consequences of having discovered major reparative medicine such as drugs and surgery (Sue's recent experience) far less healthy than we were at the start of the NHS.

Since that time, men have given up smoking in droves whereas girls are becoming chimneys to replace them.

Good luck with the interview Anne. We are moving to Canada at the end of the year because of my husbands job and I can't wait. Visa application is proving a bit of a nightmare though. HowardIf you want hordes of healthy looking nurses then we need to staff the wards at adequate levels. This would ensure that we can take meal breaks and get a drink. I have always been skinny but at times the workload at the hospital has meant days of living on redbull and packets of crisps- whilst it hasn't had an effect on my weight, I feel terrible.

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About Me

I have a rare form of Crohn's Disease. I was diagnosed 21 years ago and have had many operations to remove strictures (narrowings in my bowel that grow like tumours) I suffer daily pain, often vomiting, malnourished and weak. I take mega-strong medications every day including chemo-style immuno-suppressants, opiates and anti-sickness injections. Sometimes I am fed into my central vein by tube, other times I can enjoy a nice meal out. I have children that I often can't look after and a husband who often looks after me.
Our lives are disrupted daily by the misery of a chronic condition.